Diabetic drivers not easily accountable

FATAL CRASH CASES HARD TO PROSECUTE

He drove his Ford Ranger the wrong way down Highway 101 for 10 miles without remembering a thing. Somehow, Robert Nebel navigated the road's four lanes and curves in darkness late that September 2004 night, not realizing he was driving into oncoming traffic.

Until he slammed into another vehicle, killing its driver.

Nebel, then 42, was not drunk, as police who first approached him thought. Neither was 52-year-old John Robert Mayfield when he drove erratically down Interstate 680 on July 10, diving across four lanes and back and bouncing off sound walls. His trip ended 20 miles later in San Jose when he slammed into three cars, killing a 20-year-old couple in a fiery crash.

Nebel and Mayfield are both diabetics who were suffering insulin reactions. Both were charged with vehicular manslaughter, Nebel by San Mateo County authorities and Mayfield in Santa Clara County. Charges against Nebel later were dropped because prosecutors said they didn't think they could get a conviction. Santa Clara County prosecutors, however, are proceeding against Mayfield, saying they have a solid case.

No simple answers

The cases highlight a complex and emotional debate: To grieving families who believe diabetes can be managed, drivers must be held accountable. But the diabetic community says it's not that simple, because insulin use is hardly an exact science.

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Prosecutors in San Mateo County say that at first Nebel, a construction worker, seemed to fit in the same category as an alcoholic or drug addict who was impaired but had some consciousness and control over what he was doing.

"My first reaction was `How can this be?'" recounted Steve Wagstaffe, chief deputy district attorney for San Mateo County, about Nebel driving while having an insulin reaction. "How can you be in this state and get into a car, make the assertive action of turning the car on and getting on the freeway and driving several miles without immediately hitting anything?"

The prosecution's skepticism was dashed, he said, when attorneys read extensive medical research that showed many instances in which people "can be in this state and can walk, talk and drive. When the CHP made contact with (Nebel) at the scene, it wasn't like you had somebody who just snapped back in. He was definitely in a disoriented state."

Nebel's act came under the legal definition of unconsciousness, Wagstaffe said, which means he was in a state where he had no control over what happened, like someone who has a heart attack or stroke at the wheel.

Santa Clara County prosecutors see the Mayfield case differently.

"He was an unsafe driver because he took too much insulin," said prosecutor Peter Waite. "Too much of any drug, even if it's a prescribed drug, can cause a person to be under the influence."

Mayfield recently was charged with two counts of gross vehicular manslaughter while intoxicated and the unusual charge of driving under the influence of insulin. He pleaded not guilty Wednesday and faces up to 16 years and 8 months in prison if convicted.

One point the prosecution plans to make is Mayfield was allegedly aware he was not well by stopping his truck in the freeway's center divide. He then chose to resume driving.

Mayfield, a Pacific Gas & Electric Co. employee in the Fremont area from Paso Robles, apparently took too much insulin to counteract a high glucose level of 326. Normal levels are between 80 and 120. That apparently caused him to become disoriented. By the time he crashed his truck about 8:30 p.m., his blood sugar was a dangerously low 38.

Strict monitoring

Mayfield has Type 1 diabetes - the rarer of two types of diabetes - which requires more rigorous monitoring, including insulin injections.

Cases like Mayfield's and Nebel's, in which fatalities occur, are considered unusual. The Santa Clara County District Attorney's Office said it couldn't remember another such case. Neither could Wagstaffe.

Mayfield had his license suspended for several months after the crash. It was reinstated after a DMV hearing.

Allen Ruby, Mayfield's lawyer,has spoken very little about his client, a tall sandy-haired man with a clean-cut appearance who retained his job with PG&E, but now works behind a desk. Mayfield declined to be interviewed. Ruby has said Mayfield is suffering, and he feels deepsorrow over the incident.

Drivers with special medical conditions, such as diabetes, are not required to report the information to the DMV. However, they or their physicians must tell the DMV if they have had any episode that has resulted in impairment, such as a reaction to insulin, that makes them unsafe on the road.

Normally, when people who are medically impaired have accidents and are considered to be at fault, their licenses are immediately revoked, but can be restored.

Diabetes experts agree that management is difficult. Unexpected episodes happen. "It's unusual to never have a blip," says Rhonda McClinton-Brown, executive director of Community Health Partnership, who cautioned against leaping to convict a driver who had an unfortunate reaction.

Victims' families angry

Families of crash victims have a hard time finding sympathy for those who take a life while under the influence of a diabetic episode.

Jim Conway, father of Robert Conway, who died along with Mary Bernstein, hopes Mayfield is convicted and sent to prison. "He did a stupid thing, and we think he should suffer the punishment. We're being punished every day of our lives."

Conway said he doesn't think diabetics should be prevented from driving. They should be diligent in testing themselves and correcting problems before driving. He said there should be alaw requiring strict monitoring of insulin-dependent diabetics through the Department of Motor Vehicles.

"Our lives are never going to change, whether he (Mayfield) goes to jail or not," Conway said. "We hold hands and cry every night."

Linda Albers, mother of 27-year-old Nathan Cistone, who was killed when Nebel's pickup struck his car in 2004, said she was devastated when prosecutors dropped the vehicular manslaughter charges and is still haunted by the many questions about the crash that went unanswered. "I still have a hard time with someone driving 10 miles and not being aware of where they're going. It's odd."

Lisa Bernstein, Mary's mother, has mixed emotions about Mayfield. She says he "shouldn't have a free pass because he's a diabetic."

At the same time, she finds sympathy for him, the only one who does among the relatives of the two 20-year-olds who perished. Perhaps it's because she became insulin dependent when she was pregnant with her three children. That experience, she says, gave her knowledge about how to effectively manage diabetes. Her husband, Alex, also suffers from non-insulin diabetes.

When daughter Mary died, the Bernstein family took the unusual step of asking that contributions be made in her name to diabetes charities.

Wagstaffe can sympathize with the crash victims' families. "They were enormously disappointed. We understand that, and we felt they understood where we were. When a loved one is killed, everybody wants to have somebody held accountable."